What is Amitriptyline?
Amitriptyline is a prescription medication in the class of tricyclic antidepressants (TCAs). Tricyclic antidepressants increase serotonin and norepinephrine availability in the brain by acting at three different points, hence the name tricyclic. Amitriptyline was initially approved by the Food and Drug Administration (FDA) for treating depression in 1977 and is still used as a second line treatment for depression treatment [1, 2].
In addition to amitriptyline's antidepressant properties, it is often prescribed for other conditions, including migraines and headaches. This is because serotonin is considered a key player in regulating nociception within the brain [3]. Therefore it is an approved preventative medication in headache patients within the UK [2]. Furthermore, it has been found to be effective in treating subjective tinnitus, a condition characterized by the perception of noise or ringing in the ears [4].
Despite its therapeutic strengths, amitriptyline can cause side effects, including dizziness, nervousness, sedation, sexual dysfunction or weight gain [1, 5]. Importantly, there is a risk of becoming addicted to amitriptyline due to its neurochemical properties, and therefore its prescription ought to be regulated even in countries where substance control is not as stringent [6].
Can I Drink Alcohol While Taking Amitriptyline?
Research indicated that alcohol can significantly increase the concentrations of amitriptyline in the bloodstream. It has been reported that in plasma, a sub-fraction of the blood, amitriptyline levels reached 204% of their regular concentration when combined with alcohol and remained elevated by 127% even 3h after drinking alcohol [7]. This significantly increases the risk of side effects, which are always higher at higher drug doses.
Psychomotor symptoms are one of the side effects of both amitryptline and alcohol use. When these substances are taken together, symptoms such as swaying and impaired eye tracking ability were enhanced by 92% [7, 8]. Another side effect that is enhanced and can be particularly detrimental is increased drowsiness, for example in heavy machinery operation, driving, or cycling [9]. Additionally, memory was found to be 70% worse in individuals who had drunk alcohol within the past 3h and taken amitriptyline compared to baseline [7].
For cardiovascular disease patients, there is increased risk of increased heart rate and decreased blood pressure, which may increase risk of heart attacks in severe cases [10].
What should I do if I drank alcohol while taking amitriptyline?
If you have consumed alcohol while taking amitriptyline, it's important to keep an eye out and have a plan for managing any additional side effects. Increases in heart rate, dizziness and drowsiness are easy to identify, and you should seek medical attention immediately if you experience these [11].
If you are taking amitriptyline and have consumed alcohol it is essential you do not attempt to drive or operate heavy machinery. The interaction of alcohol and amitriptyline can significantly impair your psychomotor skills and increase the risk of accidents [12].
Interactions of Amitriptyline
Amitriptyline, a tricyclic antidepressant, can interact with a variety of substances, potentially increasing the risk of side effects. Here is a brief list:
- Opioid Painkillers (e.g. codeine)
- Monoamine Oxidase Inhibitors (MAOIs)
- Thyroid Hormone Drugs (e.g. thyroxine)
- Central Nervous System Depressants - Drugs that reduce the activity of your central nervous system can interact with amitriptyline [2]. These drugs generally act on the GABA-ergic neurotransmission system, for example barbiturates.
- CYP2D6 Enzyme Metabolized Drugs (e.g. beta-blockers, other antidepressants, antipsychotic medication)
- Acid Reflux Drug (e.g. cimetidine)
- Seizure and Migraine Prevention Drug (e.g. topiramate)
- Serotonin Reuptake Inhibitors (SSRIs) (e.g. fluoxetine)
